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Massachusetts rates for HCPCS L3762

Elbow Orthosis Rigid Without Joints Includes Soft Interface Material Prefabricated Off-The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.01 / $50.28 / $50.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.28 / $60.34 / $107.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.22 / $327.81 / $549.05
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.72 / $85.49 / $112.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.13 / $171.63 / $221.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.81 / $114.60 / $147.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $65.81 / $136.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.17 / $93.17 / $97.83
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.92 / $66.92 / $66.92
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.32 / $549.05 / $549.05
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.79 / $57.41 / $112.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.44 / $140.44 / $140.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.54 / $59.55 / $112.38